药师主导的耐甲氧西林聚合酶链反应检测在肺炎中的应用。

Pharmacist-Driven Methicillin-Resistant Polymerase Chain Reaction Testing for Pneumonia.

机构信息

AdventHealth Altamonte Springs, Altamonte Springs, FL, USA.

AdventHealth Orlando, Orlando, FL, USA.

出版信息

Ann Pharmacother. 2023 May;57(5):560-569. doi: 10.1177/10600280221121144. Epub 2022 Aug 29.

DOI:10.1177/10600280221121144

PMID:36039495

Abstract

BACKGROUND

Nasal colonization with methicillin-resistant (MRSA) can be detected using nasal swab polymerase chain reaction (PCR) assay and is associated with clinical MRSA infection. The MRSA nasal PCR has a rapid turnaround time and a negative predictive value for MRSA pneumonia of >98%; however, data are limited in critically ill patients.

OBJECTIVE

The purpose of this study is to determine the impact of a pharmacist-driven algorithm, utilizing MRSA PCR nasal screening on duration of anti-MRSA therapy in patients admitted to the intensive care unit (ICU) with suspected pneumonia.

METHODS

A single-center pre/post study was conducted in 4 ICUs at a large tertiary care community hospital. Adult patients admitted to the ICU initiated on vancomycin or linezolid for pneumonia managed using a pharmacist-driven MRSA PCR algorithm were included in the algorithm cohort. A historical cohort with standard management was matched 1:1 by age, type of pneumonia, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was duration of anti-MRSA therapy. Secondary outcomes included MRSA rates, number of vancomycin levels, new onset of acute kidney injury (AKI), ICU length of stay (LOS), hospital LOS, and mortality.

RESULTS

Of the 245 patients screened, 50 patients met inclusion criteria for the algorithm cohort and were matched to 50 patients in the historical cohort. The duration of anti-MRSA therapy was significantly lower compared with the historical cohort (47 vs 95 hours; < 0.001). Secondary outcomes were similar between groups for MRSA rates, new onset of AKI, LOS, and mortality. There were less vancomycin levels ordered in the algorithm cohort (2 vs 3, = 0.026).

CONCLUSIONS

A pharmacist-driven MRSA PCR algorithm significantly reduced anti-MRSA duration of therapy in critically ill patients with pneumonia. Future studies should validate these results in critically ill populations and in settings where MRSA pneumonia is more prevalent.

摘要

背景

耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔定植可通过鼻腔拭子聚合酶链反应（PCR）检测到，与临床 MRSA 感染相关。MRSA 鼻 PCR 具有快速周转时间和对 MRSA 肺炎的阴性预测值>98%；然而，在危重症患者中的数据有限。

目的

本研究旨在确定药师驱动的算法，利用 MRSA PCR 鼻腔筛查对疑似肺炎入住重症监护病房（ICU）的患者接受抗 MRSA 治疗的持续时间的影响。

方法

在一家大型三级保健社区医院的 4 个 ICU 进行了一项单中心前后研究。将接受 ICU 入住的肺炎患者开始接受万古霉素或利奈唑胺治疗，并使用药师驱动的 MRSA PCR 算法的成年患者纳入算法队列。通过年龄、肺炎类型和急性生理学和慢性健康评估 II（APACHE II）评分，对标准治疗的历史队列进行了 1:1 匹配。主要结局是抗 MRSA 治疗的持续时间。次要结局包括 MRSA 发生率、万古霉素水平数、新发急性肾损伤（AKI）、ICU 住院时间（LOS）、医院 LOS 和死亡率。

结果

在 245 名筛查患者中，有 50 名患者符合算法队列的纳入标准，并与历史队列中的 50 名患者相匹配。与历史队列相比，抗 MRSA 治疗的持续时间明显缩短（47 对 95 小时；<0.001）。两组之间的次要结局在 MRSA 发生率、新发 AKI、LOS 和死亡率方面相似。在算法队列中，万古霉素水平的数量较少（2 对 3，=0.026）。